Valor da ecocardiografia tridimensional em tempo real em portadores de cardiomiopatia hipertrófica. Comparação com a ecocardiografia bidimensional e a ressonância magnética cardiovascular / Value of real-time three-dimensional echocardiography in patients with hypertrophic cardiomyopathy. Comparison with twodimensional echocardiography and magnetic resonance imaging

AUTOR(ES)

Leticia Santos Bicudo

DATA DE PUBLICAÇÃO

2007

RESUMO

INTRODUCTION: Real-time three-dimensional echocardiography (RT3D) has been demonstrated an accurate technique for the quantification of left ventricular (LV) volumes, ejection fraction (LVEF), and mass. In patients with hypertrophic cardiomyopathy (HCM), in which alterations of ventricular morphology are common, cardiac structural analysis is of utmost importance for guiding adequate therapy. Although magnetic resonance imaging (MRI) seems to have better definition for segmental analysis than two-dimensional echocardiography, (2D-E), it is considered a complex test with low availability and some limitations for use. METHODS: Comparative and double-blinded study in 20 patients with HCM. All patients underwent 2DE, RT3D and MRI within maximal interval of 6 months. Parameters analyzed by echocardiography and MRI included: wall thickness, LV volumes, systolic function, LV mass, systolic anterior motion of mitral valve, LV geometric index and LV dyssynchrony index. Statistical analysis was performed by Lin agreement coefficient, Pearson linear correlation and Bland-Altman model. RESULTS: Feasibility for measurements by MRI and echocardiography was 94%. There was good agreement and linear correlation between segmental analysis by echocardiography and MRI (Rc>0.84 and r>0.85; p<0.0001) and excellent correlation between 2DE and RT3DE (Rc=0.92 and r=0.92; p<0.0001). We also observed good agreement and linear correlation between RT3DE and MRI for ejection fraction (Rc=0.83 and r=0.93; p<0.0001) and excellent agreement and linear correlation between RT3DE and MRI for LV end diastolic volume and LV end systolic volume determinations (Rc>0.90 and r>0.95; p<0.0001) and mass (Rc=0.96 and r=0.97; p<0.0001). The feasibility for systolic anterior motion of mitral valve was higher by RT3DE (91%) than 2DE (64%). LV geometric index was >0.15 mmxm²xml-1 for all techniques. There was no correlation between LV dyssynchrony index and the percentage of myocardial fibrosis. CONCLUSIONS: RT3D is an accurate technique with superior performance than 2DE for the evaluation of myocardial hypertrophy localization, LV volume and functional determination as well as for LV mass assessment in patients with HCM in comparison with MRI. In addition, it seems to be superior for the analysis of systolic anterior motion due to its better spatial view of mitral valve. All measurements of LV geometric index were above the value of 0.15 mmxm²xml-1, and such findings are compatible with HCM. No correlation between LV dyssynchrony index by RT3D and the percentage of myocardial fibrosis determined by MRI was identified.

ASSUNTO(S)

three-dimensional echocardiography magnetic resonance imaging diagnóstico por imagem/métodos noninvasive diagnosis/imaging cardiomiopatia hipertrófica hypertrophic cardiomyopathy ecocardiografia ecocardiografia tridimensional imagem por ressonância magnética echocardiography.

Documentos Relacionados

• Volumetric analysis of regional left ventricular function with real‐time three‐dimensional echocardiography: validation by magnetic resonance and clinical utility testing
• Measurement of left ventricular dyssynchrony in patients with ischaemic cardiomyopathy: a comparison of real‐time three‐dimensional and tissue Doppler echocardiography
• Real‐time three‐dimensional dobutamine stress echocardiography for coronary artery disease diagnosis: validation with coronary angiography
• Real-Time Three-Dimensional Echocardiography and Myocardial Strain: Ready for Use in Clinical Practice
• Nuclear magnetic resonance in hypertrophic cardiomyopathy.